
^ **s 



Class 



IJB373 



BookiL 




Author 



Title 



Imprint. 



Isca 



Ift— 47372-1 O^o 



INSTRUCTIONS AND FORMS 



TO BE OBSERVED BY 



PERSONS APPLYING TO THE PENSION OFFICE 



FOR 



INVALID PENSIONS, 



BY REASON OF 



DISABILITY INCURRED IN THE MILITARY SERVICE 
OF THE UNITED STATES. 



WASHINGTON: 

GOVERNMENT PRINTING OFFICE, 

1862. 



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INVALID PENSIONS. 



All persons applying for pensions, by reason of dis- 
ability incurred in the line of duty while in the 
military service of the United States, must make a 
declaration, under oath, (or affirmation,) before some 
court of record, setting forth the age and residence 
of the claimant ', the service in which he was engaged ; 
the time, place, and manner of incurring the disability 
alleged, with its precise character ; and the date of 
his discharge ; together with a statement of his resi- 
dence and occupation since leaving the service. 

In support of the averments of such declaration, 
the following rules must be observed in presenting 
the testimony : 

I. The claimant's identity must be proved by two 
witnesses, certified by a judicial officer to be respect- 
able and credible, who are present and witness the 
signature of the declaration, and who state, upon 
oath, (or affirmation,) their belief, either from personal 
acquaintance or for other reasons given, that he ia the 
identical person he represents himself to be. 

' 11. The applicant must, if in his power, produce 
the certificate of the captain, or of some other com- 
missioned officer, under whom he served, distinctly 
stating the time and place of the said applicant's 
having been wounded, or otherwise disabled, and the 
nature of the disability ; and that the said disability 
arose while he was in the service of the United States, 
and in the line of his duty. 



III. If it be impracticable to obtain such certificate, 
by reason of death or removal of said officers, it must 
be so stated in the declaration of the applicant, and 
his averment of the fact proved by persons of known 
respectability, who must state particularly all the 
knowledge they may possess in relation to such death 
or removal. Then secondary evidence can be received. 
In such case the applicant must produce the testimony 
of at least two credible witnesses, (who were in a 
condition to know the facts about which they -testify, ) 
whose good character must be vouched for i)y a judi- 
cial officer, or by some one known to the Department. 
These witnesses must give a minute narrative of the 
facts in relation to the matter, and must show how 
they obtained a knowledge of the facts to which they 
testify. 

lY. The surgeon's certificate of discharge should 
show the character and degree of the claimant' s disa- 
bility, but when that is wanting, and when the certifi- 
cate of an army surgeon is not obtainable, the certifi- 
cate of two respectable civil surgeons will be received, 
in accordance with the form on page 8. These sur- 
geons must give, in their certificate, a particular 
description of the Avound, injury, or disease, and 
specify how and in Avhat manner his present condition 
and disability are connected therewith. The degree 
of disability must also be stated. 

Y. The habits of the applicant, and his occupation, 
since he left the service, must be shown by at least 
two credible witnesses. 

YI. All evidence should be verified by oath, before 
a judge of the United States court, or some judge or 
justice of the peace, or other officer of a State, having 



authority to administer oaths for general purposes ; 
and, if verified before an officer of any State, his official 
character must be duly authenticated ; and such officer 
must, in all cases, certify that he is not interested in 
the prosecution of the claim. 

YII. Attorneys for claimants must, in all cases, have 
proper authority form those in whose behalf they ap- 
pear. Powers of attorney must be signed in the 
presence of two witnesses, and acknowledged before 
a duly qualified officer, whose official character must 
be properly shown. 

JOSEPH H. B4RRETT, 

Commissioner, 



FORM OF APPLICATION FOR AN INVALID PENSION. 

State of i 

County of ) 

On this of , A. D. one thousand eight 

hundred and , personally appeared before me, a 

judge of \liere state the official character of the per- 
son administering the oath,~\ within and for the county 

and State aforesaid, aged years, a resident 

of , in the State of , who, being duly 

sworn according to law, declares that he is the identi- 
cal , who enlisted in the service of the United 

States as a in the company commanded by 

, in the [Aere describe what ivar^ or other 

service declarant ivas engaged ^?^,] and was honorably 

discharged on the day of , in the year 

; that, while in the service aforesaid, and in the 

line of his duty, he received the following wound, (or 
other disahility^ as the case may he. ) [Here give a par- 
ticular and minute account of the ivound or other injury, 
and state how, when, and lohere it occurred, luhere the 
applicant has resided since leaving the service, and what 
has been his occupation.^ 

(Signature of claimant.) 

Also personally appeared ■ and , resi- 
dents of the (county, city, or toiun,) persons whom I 
certify to be respectable and entitled to credit, and 
who, being by me duly sworn, say that they were 

present and saw sign his name (or make his 

mark) to the foregoing declaration ; and they further 
swear, that they have every reason to believe, from 
the appearance of the applicant and their acc[uaiiitance 



with him, that he is the identical person he rep- 
resents himself to be, and that they (deponents) do 
reside in the (county, city, or town,) aforesaid.) 

(Signatures of witnesses.) 

Sworn to and subscribed before me, this day 

of . 

(Signature of judge or other officer.) 



[In case the applicant does not live within thirty 
miles of a surgeon of the regular army, the following- 
will be required instead of the certificate of such 
surgeon :] 

surgeons' affidavit. 

(Date.) 

It is hereby certified, that , a in 

the company of , in the regiment of the 

United States , is rendered incapable of per- 
forming the dut}" of a soldier, by reason of wounds or 
other injuries inflicted while he was actually in the 
service aforesaid, and in the line of his duty, viz : 
By satisfactory evidence and accurate examination, 

it appears that on the day of , in the 

year , . being engaged at or 

near a place called • , in the (Staie, District, or 

Territory) of — , he received in his^ 

and he is thereby not only incapacitated for military 

duty, but, in the opinion of the undersigned, ist 

disabled from obtaining his subsistence from manual 

labor. 

, Surgeon. 

. Surgeon. 

*Here give a particular description of the wound, injury, or disease, 
and specify in what manner it has affected the applicant so as to pro 
duce disability in the degree stated. 

-j-Tlie blank in the last line but one is to be filled up with the propor- 
tional " degree" of disability ; for example : " three-fourths," " one- 
lialf," "one-third," &c.,or "totally," as the case may be. 

g^ The magistrate who may administer the oatli to the surgeons 
must certify that they are reputable in their profession, and the official 
character and signature of the magistrate must be certified by the 
proper officer, under his seal of office. 

g^ Mode of autheniicatmg papers. — In every instance where the certifi- 
cate of the certifying officer who authenticates the papers is not written 
on the same sheet of paper which contains the affidavit, or other paper 
authenticated, the certificate must be attached thereto by a piece of 
tape or small ribbon, tlie ends of which must pass under the seal of 
office of the certifying officer, so as to prevent any paper from being 
improperly attached to the certificate. 



